Hospice: Trends, Challenges, and Solutions

Bruce Feinberg, DO; Scott Gottlieb, MD; and Michael Kolodziej, MD, explore the influence of reimbursements to providers on utilization of hospice services and suggest ways to improve advanced care planning.

Dr Gottlieb discusses how the CMS perceived an overutilization of hospice services and thus lowered reimbursements to disincentivize providers from placing patients into hospice.

Physicians should address advanced care planning with patients early on after a cancer diagnosis, suggest Drs Gottlieb and Kolodziej. These early conversations can have a huge impact on the use of hospice. Dr Kolodziej adds that this responsibility does not need to fall on palliative care physicians. Rather, these conversations can be led by other members of a patient’s cancer care team.

Dr Kolodziej explains that advanced care planning can also substantially lower the costs of end-of-life care. He comments that acute inpatient care, treatment administration to patients who are unlikely to benefit from therapy, and overall symptom burden are key cost drivers in these patients. He suggests that each of these factors can be addressed by having advanced care planning discussions to help address patients’ needs.

Aetna established the Compassionate Care program to help address advanced care planning communication concerns. In this program, extensively trained nurses interact closely with patients to ensure that advanced care planning discussions occur. Dr Kolodziej notes that the program’s goal is to address unmet needs related to end-of-life care by providing additional support to members and their families and to help them access optimal care based on their needs (ie, hospice care vs additional therapy).